Group Notify - Premium Service for Business Order by Fax Form (6 - 20 USERS) Important: Read the Terms and condition before ordering. Print this Page and Fax to 619.582.4616

Quantity Description Price Total (1) Group Notify 12 month renewable plan order form for 6 - 20 user group. We require payment for the current month and the next month on asterisked items. All fees are non-prorated & non-refundable Message Rate: $.75 per 80 character message; $.30 per gateway transaction ________ Dedicated Toll-free Line Activation $35.00 ( per line) ________ ________ *MLF -- Monthly Line Fee $19.95 X 2 ( Current month plus next month) ________ ________ *MBF -- Monthly User Base Fee $15.00 x 2 x each user in your group ________ ________ ________ ________ Sub-total: ________ (2) Service Activation Fee: ________ Create Group Database $50.00 ( 6 - 20 USER GROUP) ________ Sub-total: ________ ________ Consultation Fee(s) $140.00 hourly rate or portion thereof ( First hour free) ________ Total: ________

**** ORDERING INFORMATION ****
Billing and Company account information: No P.O. Boxes Please
Fill-in all blanks. Please print clearly. All orders are subject to credit check.
Company Name:_____________________________________________Order Date: ________________
Federal Tax ID:____________________________: or Social Security No: __________________________
User Names: Add a separate list for your group members with linking email or text addresses
Company Address:_________________________________________________________________
City/St/Zip:______________________________________________________________________
Billing Address:_________________________________________________________________
City/St/Zip:______________________________________________________________________
Company Phone#:________________________________________________________________________
Company Fax#:__________________________________________________________________________
Company Email:__________________________________________________________________________ (Company email addresses only. We do not accept Yahoo, MSN, or other personal email addresses.)
Contact Name:__________________________________________________________________________
Contact Phone#:__________________________________________________________________________
Linking Information: Please provide the following information for each group member
Linking Device Type (i.e. Cell, Blackberry, iPhone, etc):_____________________________________
Carrier Name (i.e. ATT, Sprint,Verizon, etc):___________________________________________
Device PIN number:________________________________________________________________ PIN: Personal Identification Number for each device
Email address (no text addresses) :_____________________________________________________________
. Authorized Signature:_________________________________________________ Date: _____________ Tel/Email (if different from above)_____________________________________________________
By activating the Service: (i) you acknowledge that you have read and understood, and you agree to the terms and conditions of this Agreement; (ii) you represent that you are of legal age to enter this Agreement and become bound by its terms; (iii) you are authorized by your company to enter into the agreement. Important: Read the User Agreement before ordering.

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